01/24/2016 | Ann H. Steel, MD, MA, LMHC
My goal is to raise awareness of the negative behavioral and mental health effects of excessive screen time, and urge parents and educators to make decisions about introducing technology that are based on the medical evidence rather than peer or industry pressure. Certainly the Internet and entertainment media have become an increasing part of our lives. There are numerous and varied benefits to technology and most people are able to use electronic devices without causing mental or physical health problems. But there is a dark side to this explosion of screen use, particularly for young minds. At the most extreme is addiction, which can be devastating for individuals and their families.
While “Internet addiction” is not yet an officially recognized mental health disorder in the United States, a growing number of experts in the field believe it is a dangerous and widespread problem in developed nations. Many reports identify the addiction rate of those 18 and under at eight to 10 percent. Psychologists have been reporting on the phenomenon since the 1990s and in the newest edition of the American Psychiatric Associations Diagnostic and Statistical Manual “Internet Gaming Disorder” is included as a condition for further study. While many other uses of technology can be addictive, video or computer gaming has been the most studied.
The criteria for Internet Gaming Disorder include a preoccupation with Internet games, withdrawal symptoms when gaming is taken away — often irritability, sadness or anger — tolerance (the need to spend increasing amounts of time engaged in gaming, or use of increasingly violent games), unsuccessful attempts to control the participation in Internet games, loss of interest in previous hobbies, lying about one’s use, continued excessive use despite the knowledge of psychosocial problems, using the Internet to escape a negative mood, and significant negative consequences such as loss of a relationship, job or educational opportunities.
The Scope of the Problem
“John” is a typical client in my practice. He is a very bright, introverted 17-year-old senior from an upper-middle class family. He had a handheld gaming device at age five, a gaming console at age eight and a computer in his room in junior high, when he began pressuring his parents to let him play online games with friends. Soon they noticed that he seemed less interested in doing homework, and would rush through it in order to return to his games. His grades began to slip and he seemed to be more moody. Attempts to limit his time online were unsuccessful and his parents attributed his negative behaviors to “just being a teenager.” In high school his downward trajectory continued, and by his junior year he was staying up at night to play games and was chronically late to school. His grades were so concerning that his parents worried he could not get into college; he had quit his extracurricular activities and was spending all his free time gaming. The family’s first visit with me was prompted by the police being called after a violent fight between John and his father over grades and gaming.
Any pleasurable activity can be addicting. Research suggests that in video game and drug addiction the same reward centers in the brain are involved. Clinically we see problematic use with online games, console games such as Xbox or PlayStation, cell phone games, social networking sites, movie or YouTube watching, texting and pornography. Even when parents or schools introduce technology for academic reasons, children are easily distracted by recreational content. The American Academy of Pediatrics and the Canadian Pediatric Society recommend less than two hours per day of entertainment screen time for all youth yet the average American child is spending over seven. While the intent of schools and parents is to enhance learning by exposing children to technology, research suggests that cell phones and laptops in the classroom may actually inhibit learning. In addition, it is extremely difficult to limit access to work or academic use in the home or school setting without significant and sustained effort put into monitoring and blocking technology.
How do we identify those at risk for developing problems with screen use? First and foremost is to look at access; with increased availability we see an increase in Internet addiction. The steady intrusion of screens into schools at earlier grades is an alarming trend. The earlier one starts using screens, and the more time spent online, the greater the risk. Many parents become aware very early that a particular child “loves screen time or video games” more than their peers, which is a red flag.
Anyone with a history of other addictions or a family history of addictions is at greater risk. Males appear to be more affected, as well as those with Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder and impulsivity. The earlier one begins to use screens and the greater amount of time online the greater the risk. Screen time may interfere with attachment and the normal development of communication, social and emotional regulation skills, not to mention that less time is spent in physical activity and developing potentially protective, alternative hobbies and interests. Introverts, socially isolated and awkward individuals and those who access online gaming and social networking sites are more at risk.
A number of mental health conditions have been associated with Internet and gaming addiction including most commonly depression and anxiety disorders. While emotional problems may lead to addiction, research supports what I see clinically; that depression, anxiety and social phobias are often the result of excessive gaming.
Gaming and Internet addiction, as well as the precursor stages, are treatable. In South Korea every school child is screened for this disorder annually and a coordinated treatment system is available. Other countries have Internet addiction treatment centers, and in the United States there are a growing number of specialized centers. At the reSTART Center for Technology Sustainability in Fall City, Washington, young men aged 18 to 28 engage in a comprehensive program of complete technology abstinence, with gradual re-introduction of only work and academic applications as treatment progresses.
For families unable to afford a treatment center, for milder cases, or for any family with questions, it is best to get professional advice. Unfortunately most families have sought help from a family doctor, psychiatrist or counselor who is unaware of the complexities of treating Internet use disorders, or may not be aware of their existence. I recommend doing research into a therapist’s credentials and contacting those of us who specialize in this area.
Prevention is ultimately the key to combating the rise in mental health, academic, behavioral and addiction issues caused by excessive technology use. We need a societal shift and the coordinated efforts of government, schools, professionals and families. I encourage everyone to educate themselves on this important issue and begin a dialogue with others. Our children’s future is at stake.